Neurobiological science has established that the first three years of life lay the basis for lifelong outcomes. But during this life-cycle stage children living in poverty are often vulnerable to negative influences including malnutrition, illnesses, an un-stimulating environments, possibly preventing them from reaching their full potential and perpetuating poverty across generations. Small-scale studies have demonstrated that offering stimulation and nutrition to young children can have positive effects on short and long-term outcomes, such as cognition, self-esteem, depression and other important measures. However it has not yet been demonstrated that these interventions can be scaled-up to form the basis of sustainable and effective policy towards child development. The project will introduce a stimulation program, coupled with micronutrient supplementation, to improve interactions between mothers and their young children with the aim of achieving better child outcomes. The program will follow a systematic weekly curriculum based on the natural developmental stages of the child. It will be implemented in rural communities of Odisha in India, an area where poverty and malnutrition are prevalent. It will be delivered by women from within the communities, which will have been trained for this purpose, in the following forms: (i) weekly individual home visits to the child and its main caregiver/mother, or (ii) in a suitably modified way, within the context of weekly main caregiver/mother and child group meetings. The intervention will be accompanied by an evaluation based on a randomized control trial with five variants including a control group. Data will be collected on child developmental outcomes and detailed maternal- and household-level data before the start, halfway through and at the end of the intervention. Having local women deliver the intervention is key to designing low-cost and sustainable policies. The formation of groups could further reduce costs and enhance the dissemination of good child rearing practices. The aim is to test for effectiveness and to understand the pathways through which these interventions achieve their outcomes. As such the project relates directly to the NIH mission of applying knowledge to enhance health, lengthen life, and reduce the burdens of illness. The research will be disseminated through presentations at academic conferences, to policy makers and stakeholders at specially designed meetings and will form the basis for submission to top peer-reviewed Journals such as the Lancet and the American Economic Review. Results will be posted on a dedicated website. PUBLIC HEALTH RELEVANCE: By identifying cost-effective and scalable early-years interventions, our research has the potential to revolutionize early childhood development (ECD) policies and contribute to breaking the intergenerational cycle of poverty. If the interventions we propose to test prove to be successful, our findings can form a blueprint for ECD strategies that will be applicable in poor communities, based on local resources and empowerment and capable of changing the developmental trajectories of children in a substantive way.